The budget deal's health care winners and losers

Congress agreed to a budget deal on Wednesday with significant implications for health care, and PULSE breaks down what's in it — and what got scrapped.

MONEY IS COMING TO THE OPIOID FIGHT —
The bipartisan Senate budget deal released Wednesday includes $6 billion over two years to combat the opioid crisis and support mental health programs. It would also boost National Institutes of Health spending.

The funding would go toward state grants to fight drug abuse and expand substance abuse and mental health treatment. It would also go toward prevention and law enforcement activities related to the drug epidemic.
More for Pros.

MORE FUNDING FOR OTHER HEALTH PROGRAMS, TOO — CHIP got four more years of funding, community health centers got two more, and multiple Medicare payment policies also received significant extensions.

BUT MONEY IS LEAVING THE PREVENTION FUND — The Senate deal slashed Obamacare’s public health and prevention fund by $1.35 billion, less than the $2.85 billion the House's earlier budget agreement removed.

Late Wednesday night, the Senate began the process of moving to the budget deal on Thursday. Senate leadership also posted the bill text as well as summaries of the continuing resolution and disaster relief efforts.

BUDGET DEAL'S HEALTH CARE WINNERS AND LOSERS — POLITICO's David Pittman took a closer look at how the Senate deal would affect industry groups.

— Winner: The American Medical Association and other doctor groups. They persuaded senators to drop a provision that would have let CMS shift Medicare money from high-paying specialties to more primary care services or implement an across-the-board cut.

— Winner: Therapy groups. Congress is also set to permanently repeal the "therapy cap," which limits how much outpatient therapy Medicare pays for, a move long pushed by therapy provider groups and the AARP.

— Winner: Home visiting programs. Senators included five years of funding for the Maternal, Infant, and Early Childhood Home Visiting Program, which helps at-risk pregnant women and families navigate the social safety net and wasn't funded in the House version.

— Loser: Pharma. The industry would be forced to pay 75 percent of the cost of drugs for seniors in Medicare’s coverage gap a year early. The Affordable Care Act envisioned narrowing the so-called “doughnut hole” by 2020, by raising the industry's discounts to seniors over time to 75 percent.

— Loser: Home health agencies. They're expected to lose $3.5 billion in Medicare payments starting in 2020 due to a change in the way Medicare calculates annual payment updates.

Congressional leaders hammered out a budget deal with significant implications for health care. | John Shinkle/POLITICO

A message from PhRMA:

Recent analysis shows some hospitals mark up medicine prices 700% or more. Even worse, half of nonprofit hospitals are marking prices up this much even though they already get a 50% discount from the federal 340B program. These hospital markups lead to higher costs for everyone — patients, employers and payers.

WHAT ABOUT COST CONTROLS? — The budget deal would repeal Obamacare's Independent Payment Advisory Board, the controversial initiative that would have removed some power over Medicare's purse strings from Congress. The panel was never put into effect because program spending didn't rise high enough to trigger a requirement that the board meet.

Some analysts hailed the move. "Repealing IPAB is one of the rare bipartisan agreements in health policy," Heritage Foundation's Robert Moffit said in a statement. "Many Democrats as well as Republicans have long understood that this body could do serious harm to seniors."

But another line of thought emerged: "Potential repeal of IPAB, along with continuing delays in the Cadillac plan tax, reveals a bipartisan consensus that health care cost containment generally seems better in theory than in practice," Kaiser Family Foundation's Larry Levitt
quipped on Twitter.

ALEXANDER: WE NEED GOP AGREEMENT ON STABILIZATION — Republicans on Capitol Hill and in the White House are not on the same page about what kind of policy (if any) should go into an Obamacare market
stabilization bill, POLITICO's Jennifer Haberkorn reports.

Senate HELP Chairman
Lamar Alexander says he’s close to a stabilization plan, but “we’re at the point where we have to decide — just as the budget agreement came together this week, the president and the House and [the Senate] have to decide exactly what we’re willing to do on the combination of CSRs, state flexibility and invisible risk pools.” He told Jennifer that he and Democratic Sen.
Patty Murray are still aiming to get legislation into an omnibus spending bill.

Murray, for her part, wants a deal to include an increase in premium subsidies — both the amount of premiums and who is eligible for them — in an attempt to make up for the policy changes that have increased premiums. Democrats argue that the existing Alexander-Murray bill didn’t take into account repeal of the individual mandate. She also wants to see additional funding for outreach and a prohibition on allowing insurers from selling “junk plans.” Alexander acknowledged that additional premium subsidies “would be” a big ask of Republicans, but declined to speculate further.

THIS IS THURSDAY PULSE — Where your author is still coming down from a sugar high, after getting to nosh on five different cakes from D.C.'s Buttercream late last night. (This is less of an endorsement and more of a warning: Taste-testing is gluttonous, not glamorous.) Send tips and healthy eating recipes to
ddiamond@politico.com or
@ddiamond on Twitter.

INSIDE THE HUMPHREY BUILDING

How Alex Azar spent his Wednesday. The HHS secretary had an Oval Office sitdown with Trump in the morning and posted details afterward on Twitter. "I had a productive meeting with @POTUS at the @WhiteHouse today," Azar
tweeted. "We discussed #healthcare reform, lowering #drugprices, and combating the #opioids crisis."

Azar also had a briefing with senior HHS leaders about flu preparedness and response, with the CDC's Anne Schuchat, the NIH's Anthony Fauci and ASPR's Robert Kadlec among those who presented and spoke.

Looking ahead: Azar at House Ways & Means next Wednesday. The HHS secretary will be
testifying on HHS' budget request, a routine hearing but his first time doing so. Azar has a similar hearing teed up with the House Energy & Commerce Committee budget hearing next Thursday.

Equity Forward announces Azar-targeted ad buy. The group is launching a week-long series of digital ads that it says are intended to "hold HHS accountable." The ads, which will run online through Azar's budget hearings next week, spotlight Scott Lloyd — the head of the agency's Office of Refugee Resettlement, who has
steered controversial efforts to block abortions for undocumented teenagers in the office's custody — and ask if Azar supports him.
See sample ad.

THE WHITE HOUSE

Four organizations decline global funding over abortion restrictions. Four non-governmental organizations have declined to renew U.S. global health funding because of abortion restrictions imposed by the Trump administration last year, according to senior administration officials.

Of the 733 organizations that have had to renew their global aid funding as of Sept. 30, all but four prime grantees decided to renew with the new prohibitions on facilitating or counseling on abortion, according to the officials, citing a State Department
report. The International Planned Parenthood Foundation is one of the four.
More for Pros.

OBAMACARE

ICYMI: Major swings in enrollment by state. That's the takeaway from the National Academy for State Health Policy, which on Wednesday released new a analysis of the just-ended ACA enrollment period.

The 34 states that utilize HealthCare.gov and don’t conduct their own marketing or outreach efforts saw a 5.3 percent decrease in enrollments. That was in contrast to state-based marketplaces, which saw enrollments largely remain flat, ticking up by 0.1 percent.

— Looking closer: Enrollment falls slightly in California. While new signups increased by up to 5 percent (depending on how you crunch the numbers), re-enrollments dipped by as much as 5 percent, leaving Covered California with a
total decrease in enrollment of 2 percent.

The slight decline is seen in California as a win considering the contentious year for the ACA marketplaces and the volatile nature of individual coverage, POLITICO's Victoria Colliver reports from Sacramento. And some carriers had growth — like L.A. Care Health Plan, which saw gross signups triple, due to the plan’s price points and some marketplace changes in the Los Angeles County market.

Still, Covered California committed $111 million to advertising and outreach for the 2018 enrollment period — and will likely end up with a slightly lower tally to show for it.

NAMES IN THE NEWS

Caitlin Demchuk joins American College of Emergency Physicians. Demchuk, who was previously at the American Society of Clinical Oncology, will be grassroots advocacy manager at ACEP and its political action committee, NEMPAC.

WHAT WE'RE READING

By Renuka Rayasam

Drugs and despair in rural American are largely to blame for the drop in US life expectancy, writes USA Today’s Doyle Rice.
More.

Chile’s aggressive war on obesity, which has ensnared victims like Tony the Tiger and Cheetos’ Chester Cheetah, may hold lessons for other countries struggling to curb obesity rates, writes Andrew Jacobs in the New York Times.
More.

After Robin Williams took his life in Aug. 2014, copycats followed suit, boosting suicide rates in the five months that followed, reports Amy Ellis Nutt at the Washington Post.
More.

GE’s former CEO Jeffrey Immelt was appointed chairman of the board at AthenaHealth, a health care technology company helmed by George W. Bush’s cousin, Jonathan Bush, reports Bloomberg’s Zachary Tracer.
More.

Another good reason to stay at home if you have the sniffles: flu season could cost the Dallas region $265 million in lost productivity, writes Sabriya Rice at the Dallas Morning News.
More.

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About The Author : Dan Diamond

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with politicians like Sen. Susan Collins, leaders like Kaiser Permanente’s Bernard J. Tyson and thinkers like Atul Gawande.

Along with his partner Rachana Pradhan, Diamond’s high-impact reporting resulted in the resignation of HHS Secretary Tom Price. Diamond also has done prize-winning reporting on hospitals’ community obligations and deep investigations into the Trump administration’s health care strategy, including its approach to vulnerable populations.

Before joining POLITICO, Diamond served as the Advisory Board Company’s senior director of news and communications. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has appeared to discuss health care, politics, and policy on NPR's "All Things Considered" and "Fresh Air," the NBC Nightly News, the BBC, CBS, CNN, MSNBC, the Dan Patrick Show, and other programs. Diamond has been a Yale University Poynter fellow and a fellow of the Association of Health Care Journalists.